A Health Odyssey

This is an idiosyncratic, off-the-wall tale, very much a brain-fugue by the author (me).  Cancer is a scary business, and the cure is sometimes worse than the disease.  That can’t help  but enter into this tale, because of the big role it has played in the last three years of my life, and in the life of the patient, generous, and loyal person who shares my journey with me.  (I promise, no whining. Quite the opposite, really.)   Mostly, though, this is about health care in Oaxaca now and over the years that I have been here.

I’ve tried various of the many parts of the medical systems by now, and I have probably made some mistakes, but this is an odyssey of sorts, and wrong turns do happen.  So let’s begin…

Seguro Social:

When I first came here to live, in early 1994, I had an FM-T tourist visa.  After two years or so, crossing the border every six months, on a trip back from California I was admonished by an otherwise helpful and pleasant immigration official for not getting an FM-3 temporary resident visa.  I complied, and after I got it someone at the Library said “did you know that with an FM-3, you can belong to the social security hospital?  It’s really cheap to join, and you get all your meds for free”.

[Raising the flag in the Alameda in the morning and lowering it at dusk is a daily occurance. Usually it is done by a crack team of ceremonial troops. During the occupation in 2006, the citizens did it themselves.]

Next day, off I went to join up.  Of course it took numerous trips back and forth before I finally got my little IMSS  booklet, but eventually I prevailed.  I was told that all foreigners were required to report to room 15 at the “family clinic” number 1, which serves a lot of the center of the city.  Ah, I thought: an English speaking doctor.  For a while it was true.  Then the doctor, who was active in the affairs of the medical workers’ union, was gone more and more often, and in his place was a series of bored, less-than-amiable substitutes.  Finally, he left altogether, becoming a Union executive.

Like almost all those who can somehow swing it, he had a private practice on the side.  The Seguro Social pays so little that a doctor must supplement his/her income.  The ones who can’t swing it drive taxi or work in a pharmacy.  That’s the ones lucky enough to be able to get a job in the System.  Some newly minted doctors drive cab full time.

[Semana Santa (Easter week) is one of the most well-attended tourist events of the year. These barriers were set up to sanitize the city center by keeping out any dissident demonstrators or street sellers.]

I found out that, like most government agencies, getting a diagnosis at IMSS takes several visits, and often requires the patient to go from one office to another and back again.  So it goes: time is money, and if you want it cheap, keep your footsteps within the lines and be patient.  Once you’ve learned the system, you go in at 6 in the morning, and sign up for the next available appointment, which is almost always on the same day.  I used IMSS for a couple of years.

One day I woke up with chest pains.  They didn’t last long, but I thought I should get it checked out.  I was diagnosed at once with angina, and referred to a cardiologist in the System.  It took several days to get in to see him, and he confirmed the diagnosis.

He gave me a slip of paper to take to the travel desk, where I was issued a travel voucher and a bus ticket for ten days later.  It turned out that Oaxaca, a city of over 400,000 people did not have one heart catheter lab, and that the nearest one was in Puebla, 4.5 hours away.  Off we went, Diana and I, on the day before my appointment with the operating surgeon who would be performing an angioplasty.

[For those who are not satisfied with the deal they are getting from the government, September is the month of Resistance.]

Oh, yes, he said, you definitely need an angioplasty.  I’ll schedule one for you.  Let’s see, today is March 18… oh, yes, I can do it on June 12.  I have to wait until June 12?  I said, I’m better off dead!  Oh, no, he said, if you have a serious attack in the meantime, we’ll put you in an ambulance, bring you up here, and take you in right away.

Two days later, I was on a plane to Minneapolis, where I was immediately admitted to the county hospital, held for two days (the doctors who did those procedures didn’t work nights or weekends except for emergencies), and then successfully operated on.

When I came back to Oaxaca, I started going to private doctors.  They don’t charge a lot, and I could afford it.  I also started buying my own medicines, because the free IMSS medicines were often out of stock.   Lab tests would be ordered and not done because of  a shortage of chemical reagents.  Nurses and doctors were going on strike to demand what they described as corruption and immunity in the IMSS hierarchy be investigated.   I never went back to IMSS.

Since then, a brand new Specialties Hospital – part of the IMSS system – has been built out in Santa Maria Coyotepec / Xoxocatlan.  It has a heart catheter lab.  As far as I know, none of the three cardiologists considered the best in Oaxaca ever use it, because of bureaucratic and pay issues.

Now here’s a caveat:  I can name any number of people whose experiences have been similar to mine.  As well, I can name any number of people who think the IMSS is the best thing since sliced bread.  Therefore the theme for today is “who am I to tell you what to do?”.  Mine is but one of the many stories in the naked Oaxaca…

[The atrium of the new Specialties Hospital, built by reviled ex-governor Ulises Ruiz, and furnished by current governor Cue]

The best medicine money can buy?

Since that one trip to Minneapolis, I have had numerous exams and a few invasions, and generally the results were good.  But not always.  There was the cancer, and the treatments, and the bad outcome.  Diana keeps a small condo in California, near her children, and we tend to return every spring for a visit, and to make sure our health is good.  Three years ago, I submitted to a combination of external beam radiation and a radioactive seed implant for prostate cancer.  One year ago, I underwent a surgery to correct problems often associated with these procedures.  This year, just a few months ago, I was told that I was going to have to have it done again.  I stalled.  Silly me.

The denoument, in which our hero wins out:

Doctor Z is not the world’s greatest diagnostician, nor does he pretend to be.  He’s a helper.  He tells you what he knows, and lets you know what he doesn’t know – and recommends a local specialist if he thinks you need one.  He is totally bilingual.  If, as many of us do, you need someone to interpret for you with the specialist, he will do that, free of charge.  More than one person here will tell you that he saved their life.  I am one of them.

[The late Bill Wolf, who quietly and determinedly was a behind-the-scenes organizer working with a great many progressive organizations. Bill used to be a set designer. This sign was hung up on the “Main Street”,Avenida Independencia.]

A few weeks ago, I got up at three in the morning with a strong urge to urinate, and an inability to do so.  I waited until 7 to call him, and when I gave him the details he came to my house, picked me up, took me to his office, and tried to catheterize me.  He said the blockage was too much for him, and I needed the services of a urologist.  He called around until he found one he trusted who was in surgery at the moment, but due out momentarily.  He drove me across town to that hospital, where the urologist catheterized me, and then he drove me back to his office, gave me some antibiotics, and drove me back home.  While this is not typical of the kind of service you get from the average doc in Oaxaca, it’s not unheard of, either.  According to the urologist, I was less than an hour from a burst bladder when he saw me.  He explained in detail what was going on, and told me that I would need to be hospitalized and have the blockage repaired.

The hospital where I had the procedure done has maybe 20 beds.  The operating room was small but modern and sparkling clean.  I had an anesthesiologist, two nurses, the surgeon and Dr. Z in attendance.  The surgery took a couple of hours.  I left the next day.  The total cost – including follow-up – was under 3 thousand dollars.  Of course that doesn’t include the pathology lab report (totally negative) and various and sundry medications that I had to take while recovering.

For me, the thought of going back to California is just depressing.  I have a place to stay, but it’s far from my urologist.  I didn’t have a companion to kvetch to.  I do have good friends in scattered locations, who have offered help, but it’s a lot to ask…  I certainly don’t have a Dr. Z.

[One of many “mega marchas” that remind us that loving one’s country doesn’t necessarily mean that one is happy with one’s life.]

Everything takes too long “up north”: the entire elapsed time from waking up all too continent to the discharge from the hospital here in Oaxaca was two weeks.   It could have been done in a few days, but the surgeon was on vacation.  In California, I wouldn’t be able to get an appointment to see a G.P. for the first level of referral in that amount of time;  and by the time I actually got the surgery, I would have been wearing that catheter for a heck of a lot longer.

On the other hand, I had to go into debt to pay my bills here, where MediCare doesn’t yet pick up the tab.  Like it or not, another angioplasty, or other cardiovascular procedure, would force me to travel.  But that’s me.  You may be younger (for those under 70, there is relatively low cost insurance available), or more solvent.

Like the U.S., or anywhere, medicos in Oaxaca can vary widely as to competence.  There are some good ones and some quacks.  I’ve always believed that it’s better to be lucky than to be smart.  I guess I got lucky.

The moral of the story

is that even hypochondriacs like me have real illnesses from time to time, and when it happens, it’s good to have a plan to deal with it – and even better to have a doctor on your side; and that true expatriation creeps up on you over time, until one day – like me – you try to pick up your feet, and realize that you really have grown roots…

[Mexico reveres a great many martyrs. This gravestone, in the big central cemetary, celebrates a different kind of martyr:those who, it says, died at the hands of the “bad government”.]

Addenda:

**Costs also vary: It would have cost me 4 thousand if I’d gone with the original urologist.  Imagine, a medical system where you can bargain over a surgery as if it was a rug… and where you bring cash up front, give it to the lead doctor, and he pays everyone else.  No bills, no fuss.  “Oaxaca”, Max used to say, “Ya gotta love it”.

**Medical care in Oaxaca is not a new subject for me.  If you go to our “Frequently Asked Questions” page, you will find a discussion of sorts on the subject.

**For a few years, a group at the University of Texas at Austin has been developing a protocol that would allow the Medicare folks to reimburse Mexican doctors and hospitals in much the same way as it is done in the U.S.  Rumor has it that they are close to putting together a deal where a licensing board would contract with providers in Mexico, and would process the claims.  The rationale for such an arrangement is obvious: the costs for Medicare would be cut substantially; as would the out-of-pocket costs for the uninsured, like us.  So far, no announcements…